Preoperative Ultrasound‐Guided Incisional Biopsy Enhances the Pathological Accuracy of Incisional Biopsy of Cutaneous Melanoma

Abstract

Objectives-To assess the feasibility of preoperative ultrasound (US)-guided incisional biopsy through a prospective controlled clinical trial.Methods-This was a prospective, double-arm, single-center study of Chinese patients. Thirty patients were enrolled in the study. Fourteen patients received incisional biopsies for which the choice of biopsy area relied on a clinical evaluation, and 16 patients received incisional biopsies for which the choice of biopsy area relied on a US-guided evaluation. The following procedure was used in the US-guided incisional biopsy group: 1) clinical and dermoscopic evaluation of skin lesions; 2) US examination; 3) incisional biopsy; 4) surgical excision; and 5) histopathological examination. The same procedure was used in the non-USguided group except without US examination.Results-In the non-US-guided group, the mean tumor thicknesses obtained from incisional biopsy and postoperative histopathological examination were 2.1 and 4.1 mm, respectively. Seven melanomas were underestimated by incisional biopsy, resulting in margins narrower than currently recommended. In the USguided group, the mean tumor thicknesses obtained from US, incisional biopsy, and postoperative histopathological examination were 3.4, 2.9, and 2.7 mm, respectively. In only 3 melanomas was the tumor thickness of the incisional biopsy less than that of the postoperative histopathological examination, demonstrating that US-guided biopsy obtains the maximum thickness area.Conclusions-Preoperative US-guided incisional biopsy can enhance the pathological accuracy of incisional biopsy, which may allow us to better perform surgical excision with safe peripheral surgical margins.

Top Advances in Dermatologic Ultrasound

“…This is the most lethal cutaneous tumor, and ultrasound can support the detection of the primary tumor, its extent, including depth; therefore, it is possible to provide an ultrasonographic Breslow index of the cutaneous melanoma. 6,24,37,38,73,[87][88][89][90][91] On ultrasound, they tend to show as oval or fusiform-shaped, hypoechoic dermal or hypodermal lesions. However, deep melanomas may appear as bulky masses with prominent hyperechogenicity of the surrounding hypodermis due to edema.…”

“…On color or power Doppler, they tend to present prominent vascularity with low-velocity vessels (Figure 12). 6,24,37,38,73,[87][88][89][90][91] It is possible to perform a locoregional staging of the melanoma that includes the detection of satellite (<2 cm from the primary tumor), in-transit (≥2 cm from the primary tumor), and nodal metastasis. 37,38,87,88,90 Metastatic lymph nodes of melanoma commonly present a round shape, prominent hypoechogenicity with loss of the hyperechoic medulla, and chaotic cortical vascularity.…”

“…On color or power Doppler, they tend to present prominent vascularity with low‐velocity vessels (Figure 12). 6,24,37,38,73,87–91 …”

“…This is the most lethal cutaneous tumor, and ultrasound can support the detection of the primary tumor, its extent, including depth; therefore, it is possible to provide an ultrasonographic Breslow index of the cutaneous melanoma 6,24,37,38,73,87–91 …”

The utility of high-frequency 18 MHz ultrasonography for preoperative evaluation of acral melanoma thickness in Chinese patients

“…Unfortunately, such an inspection cannot be performed using devices with a probe frequency of 20 MHz or higher. In our previous research, we observed that the utilization of the 18MHz probe resulted in improved localization during incisional biopsies in patients with AM ( 16 ). This finding suggests that the use of the 18MHz probe can aid in accurately identifying the target area for biopsy, facilitating more precise and targeted sampling of the lesion.…”